HomeMy WebLinkAbout020-1109-40-000 o y o c n J Col
o � c d o
o on ' 3 m C1.
0 d
CD g N
O
;; 2 4 to
O N O C • FD d a m no r' _ o n CD a ■ D h O
to z D o— a t';14.
CO 0
0 D w a �- C
0
o N
0 c
0 a.
r.
o o a
w 0 a a • la
0 °� ",I
co - o c \',.'-...N.NC 3 cl-
y j9 . a
CD
m
.r �
cu
D
C z
�'c fD
H
m N
o a z
c
o
z -I w
o
a.
a 0 m co") rn
° z
3
a.
So? z
A
A
a
sc* o.
O
' w c
o a
if te
�a
b
3
r4
A
o
C0
o 0 •
A IA
CO CD CIO ti
8 O *." V
i0 0 £ v , a
r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 430294 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Bast, Kernon Hudson Township 020 - 1109 -40 -000
CST BM Elev: Insp. BM Elev: BM Descriptio y./ Section/Town /RangelMap No:
1 AO ' 6 g° • d �� l / -- nt lof /i ru 7 31.29.19.442A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
rah 1.2 6 6 1.1C iti5tK g a s
Dosing Alt. BM
6 0/ A �r /l i - w , Z•yi /0 /• Y7
Aeration Bldg. Sewer
- _ .6'78 4; /7-
Holding St/Ht
St/Ht Outlet
TANK SETBACK INFORMATION •'3 / (,
TANK TO I P /L ,,�, �yy �y ��j B�r
WELL Ve �1� Air Intake ROAD Dt Inlet �_
�fl
Septic � I" _/ �� :6 Dt Bottom /
ti
Dosing Header/ an. "7 , q G 3S
Aeration !i — —�
::stemc� 6, ___ __ S Is'a zs'
PUMP /SIPHON INFORMATION Final Grade /�
Manufacturer Demand St C� ��' Y �
PM .a �Q'
- - 7 — 3 y ;y5 Z -7 /0 /. 2-c
Model Num:: --
TDH 'Lift > tion Loss System Head TDH Ft 1
Forcemain Length Dia. Dist. to Wel
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS `CJ' 7 r1 [
SETBACK SYSTEM TO P/L 3LDG laill LAKE /STREAM LEACHING MaR4tur_ ler •
INFORMATION CHAMBER rJ 'roam % eF�
e Of Sy
T stem:
,_ ^ . _ ( / (D
Model Number:
DISTRIBUTION SYSTEM /L{ / / , � � / Clt,44
Heaader/Manifgi- Distribution f x Hole Size x Hole Spacing V nit to Ajf Intake d,s
/ . N Pipes) 0 �� —� {/, j-
Length (�/ Dia Length V Dia Spacing 3 ' JV
r ! . ( 6lJ
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
d c ig. a
Depth Over �/J Depth Over xx Depth of xx Seeded /Sodded 3 ' • u ed
Bed/Trench Center / �/ — Bed /Trench Edges Topsoil
H
L �, D �" t�� _� i Yes i _ J No , Yes No
COMMENTS: (Include coc! iscr p ncies, persons present, etc.) Inspection #1: y / / U 3 Inspection #2: / /
Location: Ridge Parcel No: 31.29.19.442A
0 656 Mary Jo Court Hudson, WI 54016 (NE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 1st Adt1 Lot 70 Pa
1.) Alt BM Description ._00 wed( Ot,v- , 6 6 ,- -
2.) Bldg sewer length = lc -4--/- e�0 vim+ ' � !filsicw
- amount of cover =y //r
Plan revison Required? LI Use other for additional Yes o n n ` L // � j ! 46.-S--- '
Yes
SBD -6710 (R.3/97) Date Insepctors • ature Cert. No.
, .1 t i 6 / I - /o 1 Ph / .1 afkl _5 i d e &/ nckk r.5• .
--_: .--.1-. ...' :..:.___ . .....„ ._____.. ... ) .././.42,6.e.c ij
1 01 I
_ LOT .. A
ow+� �I�VS t''
(3 M Top A Ster1
1 teoRo • , Piel ( ".A °w and
) (0
C-P '-'-
i � t---- as � 36‘-t- 25
(u5-ft ■ - — '3. e'.-ar
'\/ , l/
• 4--- , 4 . \
e3 A 4 / 3k 07.5b •
vs & Hoy
Ar k� 1c
su'
T r:.).
lay' o p of ''a'' sttcl P'
— I (o" Abort 9" lo_
A ---.
. u► ., •
jj1 R4 > if f Y. 1
(----::. HI 1 4s, 00 0 c
i n • i •• iUll .
A 1 � �
b, ( ----...1,,01 . ' II1J -... . ,,
of ,„,.,, .,....,
..„,...,
,,, ..,..,
,,,,. A t
Z T) 1111 (( „., ,g
a....
,..... t, .
„......... ; . : , ...%, „51
„:, ,
uj
�� �'� ` iii l�L W 1u K
. al s . ;f: -0 :3 0 T ,,r,`t 7 [1 . . . •
i
1
ifs /WAIN 70 us.. Safety & Buildings Division
Sanitar Perm A >l ication 201 W. W x Ave.
' NSi
isconsin y Wi 15 Box 7302
PO
In accord w(th Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302
Deportment of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)) state owned.)
Attach complete plans (to the county copy onlyyfor the system, on paper not less than 8 -1/2 x 11 inches in size.
County ._ , I State Sani t 1 g it
Permit Number ❑ Check if revision to previous application Slate Plan I. D. Number 10019 1
I. Application Information - Please Print all Information Location:
Property Owner Name n Pr / operly Location
1 f� /1 D r l --°.
5 °. _- /t e I/4 J I I4, s 3/ Tr ?9,N, Rift (ott
Pro tierty Owner's Mailin Address R E C, E 1 \ Li) Lot Number Block Number
gig l.A1Harcie, a
City, State 1 Zip Code Phonbel 5 20 0 3 Subdivision Name or CSM Number L
a.)-1 MJ $1
.5 6 • A . - AI L
II e
Type of Building: (check one) f is 2.v. ❑ city
`�� �
ik 1 or 2 Family Dwelling - No. of Bedrooms: _ 1.7 1 4(71P74 it I' ❑ villa owrgof
0 Public/Commercial (describe use): ' / /
0 State -owned 74/i1C 50/)
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nea t Road ---,
A) 1. New System 12. ❑ Replacement 13. ❑ Replacement of 14. ❑ Addition to Parcel Ta umber(s) TZ
System Tank Only Existing System ,,,e) nog- -000 ii
B) Permit Number D ate Issued
❑ A Sanitary Permit was previously issued
V. Type of POWT System: (Check all that apply)
Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
Pressurized In- ground ❑ Ilolding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade 2 3 r k 1 E /t1.hs - . ❑ • robic Tre me Un' ❑ Re 'rc ` ati • ❑ Other:
gel .sio met►►.. A .
V Dis' ersal/Treatment Area Information: 'r!rilL - lab Vt ," ff tt7t
1. Design Flow (gpd) 2. DispersalArea 3. Dispersa rea 4. Soil Application 5. Percolation Rate !. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
(Q 06 8 87u .7 -- C5_0b 99.
VI Tank Capacity in Total 1/ of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks • _
ii — 1I i : _ : _ ❑ ❑ ❑ / -- 1 12. / ❑ ❑ ❑
VII Responsibility Statement.
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na nt) Plumber's Slip* ,(no stamps): . MP/MPRS No. Business Phone Number
Plumber's Address (Street, ity, State, Zip Code d -
/07o , )1 iti / & AL: 5 0/6
VIII County/Departtent Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 1 sui Ageu Signs (No stamps)
jk pproved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination
IX. Conditions of Approval 2.5t-"------- .t7z3
roust /Reasons for Disapproval: rovalt '
PP PP '
,.
3) o ►�a c�4 21
SYSTEM OWNER: J �-�-- �
1 Septic tank, effluent filter and ' , J� - .� e �„ - - A,-
dispersal cell must all be serviced / maintained
as per management plan provided by plumber. `a ' 4 COAKVAA C 1 e .
2. All setback requirements must be maintained
as per appncaoie coaeloralnances.
... K ti ii. * w / t . . '0 t: / r /Cy., afkt _5 61 e 0i nc[e rs5
_no. a_44.014 __ ...._......- .. M4M_ E ... _ �'f.m_. � o u.r�.e� )e%:'. ...
/'_U /'ir��l u, - . e . / ..L../Ce.n5e �� �yU... _...__.- __...
IP o � 4
. .
1 i3-to itoolt\„ Psi to L'.abY 3"
m il -f A Si" ee‘ t
p S CP ---- '
,s Q , -
(3 A) 1
. a 1 c L,
3k ?7 -Sb .
-So'
, p of la° 5+' l Pi
(v" QLurt yea ►o-7
U -e ) );tip
i 117 i --- u, ./
� � Q ot0n, S iti INN 3
9coo 0 C
1 qq .
0
N o W A
i . N, _.3 •
i te r 1
, , 7 I ''. -.• --- - ' -‘ t
IX ( ..... E x al
W
0 i i w t g .
z . T6 1, . rili * . ...a t 1
!.. , , ,, • 1
b s.
o H
w s... 1 i .. .
vi in ... a.
g
CO !.1 , ■ 'i r, 1 x . ti ci,Ec ? t 1 i
Immo .e 1 r 0. • • • •
u `eR ' , p ev& - i _ o p ; l'E/R,t)o,o /3/45 r 3 76,vN4 SPEL 72 /3/4s r
9 y,le IA- 8A-R6-e 'D Hvpso w/. s ''b /Ce ' . . , .
V vi s oonstn . Department of Commerce 4 SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code /�
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r G " °!
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. S.Gt. //6 w .-
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re ewed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m)). �, ` . 4- `i 1 _ _ ') • O C
Property Owner C E 11/E D rt y Loca tion fi 4F u> a1.
NE/L, /�- o0)C.S . Lot s 1/4 /Jk4 /4 S 3(2 T 2 7 N R I f(or) W
Property Owner's Mailing Address ' # Block # Subd. Name or CSM# ,VO /,t,1� y Oy4 7 --
. g /4 c7X may. , o 2003 �� C 6 � (Lo p 4 � /Sf /4 cid .
(al' y State Zip Code , P itt; ir o i City ❑ Village 0 Town Road •
//URSOA 14v /• 1 . ' ■ g1- #VPSO,- 1 //toy
I2-New Construction Use: al Residential / Number of bedrooms 3 -y Code derived design now rate / fa — Co aZ GPD
❑ Replacement ❑ Public or commercial - Describe: ___. _
Parent material /o &SS oV i '54A� GV TWv*S4 Flood Plain elevation if applicable N�� - ~v --
ft
General and re ndaeons: ' /1 4- TEST &O, So/ r/0 /,L_ co/e 4x /,! ,povvp
ee,v1/4 P.4.11) • T S. (Bee)°, f- 'ctSe/L, ea. Its ) •
•
/ eat # 0
pit Ground surface elev. ' ' " 5( f Depth to limiting factor > f in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI
In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2
/ O -? /Oy/Z /3 L. /f5hK M4� CS 2 . i •
z 7. /o v2 We St L. 2 -fS4A .► ' as /7 • s • s
3 22.3? 7•s y�eYCz c L5 /44, f, d.2 4..5 -- . 7 /- .-
V 39.9/_ /d //g 5/4" -- 4Q. 5 0,1 di --- . / . .
( `lg.3
Z kiln" ❑ B°ring
v
I Pit Ground surface elev. ft. Depth to limiting factor 90 in Race
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ f
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'E
/ o. /o0 /3 L /t5i/c /1 C'S 2 l- , 9 ,:
3- 7.262 /DYre ,t!v . SIC 2fJ4x .� A. a. s / f • S • h
3 2(.•32- 7. • , ____ --_ 5 c. / ,-- vim' c -- . • 4
3).92 7sVAy --- L s' /,� fR eQ,t cs — . 7 /. Z
S elr90 /open /v._ -- ,• 5 0 •54. IL — . 7 / Z
i • Eff #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/I- •
CST e 7?o /3ER r Zl /M'i ch 7 signan 2 U 3 l
Address Date Evaluation Concluded Telephone Number
Ulbricht ,!t Associates r DAC • 49 — 20 o Z 7/5.3 49G ' VS'.S
v ilvdtu fodwagiEriolionitill
C55 O'Neil Rd. �•
Hudson, Wis. 54016 -X- Av
Ni F
S'E or No 02o- //09 .20 • oazo .
•
•
,..
�,., 1) . /
�3 Go (.",
020.I / 0 y. go
Property Owner /ue! L to/ C 01C S ON 01D • //b ? • 0 ' � z. 3
Borin #
Parcel # Page of
3 � ❑
In Boring /00. ,y > 9 6 ,
it Ground surface elev. ft. Depth to limiting factor In. .
Horizon Sol Application Rate
Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. i Munsel: • Qu. Sz. Cont. Color Gr. Sz. Sh. •Effl1 'Ef#2
/ ' d' /z- /oy, 3/3 - L «'sk ! ' c fa 2_f . 4 , G
2- /a l $ /° %f y4'--- $IL. / 7 440c. c.. /)c . 2 . 3
3 X8.29' 75 vAVic 5 /L. z#, ix- ' q,s . . — .5
r 12•9v /o We y — ,> . s o ,S3 ,.Q -- . -2 /. 'Z,
g (4� (o
I w # ❑ `go^�
❑ pit Ground surface elev. ft. • Depth to limiting factor
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIW
In. Munsell Qu. Sz. Cont. Color Gr. Sz. ph. 'Ef#1 'Ef#2
.. 4
I I Ong # ❑ Boring / . .,
❑ Pit Ground surface elev. ft. Depth to limiting factor In.
Horizon Depth Application Rate
Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •E1f#1 'Ef#2
t
•
I I Boring ft Boring •
❑ Pit Ground surface elev. ft. Depth to g fades In.
Sod Applkaltion Rate
Horizon Depth Dominant Color Redox ption. Texture Structure Consistence Boundary Roots GPO/ff
In. Munsel Qu. Cont Color Gr. Sz. Sh. •Eff#1 'Ef#2
P
•E #1 > rr
Effluent # SOD. 30 <
and TSS >30 < 150 mgll • Effluent #2 = BOO < 30 mg/t. TSS <
s . and 30 nlgll
The Department of Com rce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
sawno er.sroou
■
r
p
. . a V Q
0 �1._ a_ „
J
i � 1 < k k.n ,_ . % ,,
......„,,,___. 7 . , q --- VN
i \ 'Z
e
l ` ii • .
- 1 \ . \./ \ ./..---- \
c. ■ °
Z■0 •-■ \
■
' N O N 8 N ��/
d ^ as c . 0 _ 3 N V
3
a) O d (D I-- .
O U O Ird 13 O
N � C1� _ _ 2 % ---- 13 _ a a) aD
'4 A N m O y M
I iUccw =i
Y
\ ' ';' 1...
M
o
\ t., A ` �Q
a
■
■
1 o :°
�'
.....* 1::: t
f - ,
r c�` %,
, \,..... .....,_,:. _ ' ° 1
r
s
p
1 S -cl
,
IT.
, ,
Private Onsite Wast Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
. System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 1-1.3 O 29 q
Number of Bedrooms `Y
Design Flow - Peak (gpd) OL)
Estimated Flow - Average (gpd) `f co
Septic Tank Capacity (gal) / t U
Soil Absorption Component Size (ft') $ 7
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
_ Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) 4 0 . 1:7 1 c , 0q� 8717
Maximum Influent Particle Size (in) i 8 0 1/8
Maximum BOD (mg /L) aao 220
Maximum TSS (mg /L) ISO 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
•
The septic tank shall
p be maintained by an individual certified to service septic tanks
Y P
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. Th - outle le s a • e txilt:i• iki.- 111a.r:4.- -1:r , • ensure
proper operation. The filter cartridge s • • • not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound,
defective, or subject to failure must •
P Y p 9
be replaced. Exposed access openings greater than 8 -inch es in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
9 99 9
2
L
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester &
Sons _
o s Excavatin
g 386 9020
•
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer /l e'reicia1 / ' S .
Mailing Address g _ a .I.- -- Pte. m _s/ - / V0 /4
Property Address Aff (05G
i i • CA-4)4
( V e r i f i c a t i o n r e q • f r o m Planning d ep : • •'ent for new construction) , ...ia
City/State ed/ Parcel Identification Number
LEGAL DESCRIPTION
Property Location NC ' , V4, sec. 3 ,T0 N -Ri f W, Town of /I 5'0". .
Subdivision 6 f t'a i..•• OGe 1 ie ,4, -e,„1„'" t . Lot # 70 .
Certified Survey Map # , Volume , Page # - 7( s ) Warranty Deed # . g 5 , Volume (9/ .7.-4t, Page #
Spec house ❑ no Lot lines identifiable ,'es ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
verifying that (1) the on -site wastewater disposal system
lumber, restricted lumber or a licensed nag ( )
lumber, journeyman , p Per
tnastorp ,1 YAP
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
State of Wisconsin. Certification
forth, here' � set by the Department of Commerce and the Department of Natural Resources,
set rth, y �P�
sta , , : .1 ( • tic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
e • iration date.
;.w 5
SI '` A i , OF APPLICANT DATE
OWNER CERTIFICATION
(we) ✓ ; that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the • • . Bove , by warranty b virtue of a deed recorded in Register of Deeds Office.
AI
h'
, K 3/03
SI , A t APPLICANT
DATE
* * ** • Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
erence is made in the warranty deed
a copy of the certified survey map if ref tY
J 2135 P 3 ca 49 aco
KATHLEEN H. MALSH
WARRANTY DEED RE OF DEE
Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD
Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PM
and warrants to Kernon J. Bast the following EXEMPT
described real estate in St. Croix County, State of
REC FEE: 11.00
Wisconsin: TRANS FEE: 2880.00
COPY FEE:
CERT COPY FEE:
PAGES: 1
Exception to warranties: all easements and restrictions of record.
This is not homestead property.
Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20-
1109 -10 -000; and 20- 11 -90 -55 -000
Name and ra sNs ZO:
A parcel of land located in part of the Southeast 1 /4 of the tai ealty T itle
Northwest 1/4 , part of the Southwest '/4 of the Northwest 400 South 2nd Street
1/4 , part of the Northeast '/4 of the Southwest 1 /4, and part Suite #115
of the Northwest 1 /4 of the Southwest 1/4, all in Section 36, / s on, WI 54016
Township 29 North, Range 19 West, Town of Hudson, St. INA
Croix County, Wisconsin described as follows:
Commencing at the South % corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West
along the north -south 'V4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526,
page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing
North 00 degrees, 10 minutes, 01 seconds West along said North -South 'A line, 1977.22 feet to the South line of
the North 350 feet of said Southeast '/4 of the Northwest '/; thence South 88 degrees, 49 minutes, 51 seconds
West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09
minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on
1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19
seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence
Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78
degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described
in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75
feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line
523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County,
Wisconsin.
Dated this day of J G6 —JCL , 2003.
'1 L. ilcox on Mary J. " o on
ACKNOWLEDGMENT
STATE OF WISCONSIN ) �( PC/ �1� .
COUNTY OF ST. CROIX ) -tti_ / .'D e,lM
Personally came before me this day of Jl ?1 2003, the above -med Neil L. Wilcox b ' d Mary . C r if
Wilcoxson to me known to be the persons who executed th folegoing instrume acknowledge the m i. *
PRESTON .
Nota Public — ,, -6. : hj I 0 2 G .
My commission expires: 9QF VUI SC 0
This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 d F W t
.
O 2 2 II CO d I
N O `Z I a) II I
m �� -- Z °� • \ \ O N 0 • ^ 1 cci IQ
\ \
e or
N. d ► I 041, * 1r- \ r S s2 ! z
O - v s� \, `, O x7'29 w 184.05 I I
Zz SeolbO SOS/1 1
i t 13S 3did A373 �,
I VI NOB / „l ct I 7%:::::a,
{ � H HON38 ° �\ a�6
N .) t., b 0.� — .� z6 —. —. 0000l C •
h�a s,L • �eotis
/ 8Z'69Z 3„1.00 I °00S
\<.: . J o '/ U.
/ • � 069Z M, L0,0 LoOON C
• O - — •--- -- - -'�
•
/ (:',, • '�
/ /
/ / I • . \ / / I im
� `6 `°0e/V / aa � `�' h O • I rn
^ ,a G I Z • •
• / 1 s , • ,
. • _,,,k .: • 1
• .
. • ;,-) 0 Li g : ]
� . O N owl N g
• •
• / ,' / • • 0 ' Po z .-. CA
: / aohy / . • °s A
\
• ! / ri -4Qb ` • • i
• •I 1 w Q
I _ ,9 9 0
� ^I n T co L LL o
IN NI O ,L I a
I- I
cc T <0
I � 0
w N o
N I O
3 1 � v f,(1 /\/ \`/ N u fn
O
* `
4
• 1,
■
X 1-2